T Nation

35mg of Cialis Stopped Working for Me

I will make this short and simple. To the experienced members please give me as much advice as possible. So I am 32 and I started TRT when I was 28yrs/old. I have always had to use Cialis for assistance for decent erections. But my normal dosage is tally no higher than 20mg. Well lately I have had to bump up the dosage to about 35 to 40mg just to get a decent erection. So I talked to my doctor to get his input and to see if he look at things form a different angel. He told me he thinks I may have something called a venous leak basically. Now with that being said let me say this when my hormones are in a good place and my body feels decent. With 20mg of Cialis I have no problem holding a erection and from my understanding when someone has a venous leak they most likely will not be able to hold a erection even if they took the whole bottle of Cialis because despite how much blood you push to the penis it will not hold because of the leak. Now honestly I do not believe I have a leak but hey the only way to really tell is through imaging.

Now this was his offer for a solution. He said I mite want to consider an injection called thymosin beta 4. Basically what it’s suppose to do is repair some of the tissue that is in your penis and maybe help seal up that leak. Now for those who are familiar with this please give me your input and your advice using this injection,

Quick update on my protocol and also some advice on why you may feel like even with Cialis why I can not hold a erection.I will say this before anyone else does. No I do not have depression and no I am not on any other meds other then testosterone and HCG that maybe causing this ED that I am having. And also no I do not masturbate which I have an understanding can cause so form of ED. I honestly believe it has something todo with my levels.

So my current protocol that I am on is 20mg of testosterone everyday injections and 250I.U of HCG EOD injections. Here are my labs

Any SHBG results?

have you recently adjusted your protocol? Each time I make an adjustment, I find Cialis stops working regardless of dosage. When my protocol was ~175mg/wk, no HCG, no AI; my test levels were similar to yours, but E2 higher. Cialis didn’t work. I lowered my dosage to where you are ~140mg/wk (EOD) and Cialis started working after a few weeks. I added a little bit of AI and things are working well now, after about 4wks. Will continue on current protocol until October then test bloods (I also switched from name branded Cialis to Tadalfil troches made by a compounding pharmacist, mainly as a cost savings measure. I have gone back and forth a couple times and have not seen a difference in performance; other than pill might last a little longer - but either way i am good for two days after dosing).
A number of people have reported that cialis stopped working for them during transition periods until they reach a stable state.

Stop the hcg and see what happens…

Damn. I wish you’d have never said venous leak. I googled it and have every symptom :sob:. Looked at the surgery procedure, complete with pictures, and it doesn’t look fun.

This is potentially the issue, as it affects E2.

However, i think a likely scenario (besides E2 being too high) is that E2 is too low for that TT level… SO, stopping the HCG may be counterproductive.

That’s why i wanted to know shbg level.

Hey @roscoe88 no I didn’t get a SHBG level done but I can definitely run one soon if you think it would truly help figure out what is going on. But I am interested in the statement that you made about the E2 may be too low for the level of my TT. Can you give me knowledge on how SHBG may help you figure this ratio out. If looking at your SHBG truly tells you this I probably will consider making sure I run a SHBG lab every time I run labs moving forward

So currently I am not taking any type of A.I. And to answer your question no I haven’t made anytime of adjustment to my prtocol it just seem within time cialias started not to work as effective. I have a question.
You said you stoped taking your HCG why were you on HCG to begin with was it to make sure you stay fertile? And if so are you not scared if you stop taking it that you will become infertile?

Do you think that maybe you could have had a E2 problem so maybe by lowering your testosterone dosage and addling a little A.I might have brought your E2 levels down little which in turn gave the Cialis the chance to start doing its job. What is your outlook on why the cialis maybe start have working for you?

Don’t jump to conclusion to fast bro there is alot more that goes into it then a google search lol. But what are your symptoms if you don’t mind me asking ?

1 Like

can you tell me the thought process behind this idea so I know what I would be trying todo?

HCG can screw up the e2 level that your body wants. As it tends to increase it.

And it can have other negative affects for some.

You can always restart it again. I would take it away for a good 6 weeks and keep everything else the same.

You take anything else like dhea etc?

Shbg doesn’t have much to do w the ratio

Some
Believe your tt divided by your e2 should be between 16-20 or so.

Are you on HCG?
No the only thing I am on is HCG and Testosterone
I think thats not such a bad idea but what happens when I start the HCG back up. Wont I be rite back in the same position?

ok so I see what you mean with the ratio.
But was the logic you were thinking with the SHBG so I can understand?

Shbg will determine how
Much FT and FE2 you have floating around in your bloodstream as opposed to being bound up and rendered inactive by the shbg.

Too much FE2 may interfere w libido and erections. Too
Little as well.

I took hcg for a week did not feel good

If you stop hcg and you feel great you would not restart until you want to have a baby.

no, i have never been on HCG. I’m 46yrs old and neutered, i’m not concerned with fertility. And after dealing with a hydrocele for years and a subsequent surgery (which i believe the trauma from those contributed to my low T in the first place, but i digress); a little testicular atrophy is lot horrible.
As for why Cialis started and stopped working, i don’t really know, but two of the times it happened to me was after protocol changes. Also had it happen prior to TRT as well; so I really have no idea

Whenever pde5s stop working
For me it usually when my e2 is too high.

OK this sounds like good information

So my next question is where is a good place for someone SHBG to be at to have the proper amount of FE2?

My next set of labs after the one I post now will have SHBG so you can help me figure it out if you don’t mind

looking to start a family of my own around December. But I have tried testosterone without HCG before and HCG made me feel better.

But I will say this I find it a little more difficult to get dialed in because I am dealing with two different medications at the same time